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N.E. Kanterman, J.D. Baker, F.J. Elsas; Surprising New Null Point Following Kestenbaum Surgery . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2741.
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Purpose: The purpose of this study is to present and discuss 6 cases of unexpected change in compensatory head position (CHP) following Kestenbaum surgery, as well as present data regarding what surgery to perform to reverse a CHP overcorrection following Kestenbaum surgery. Methods: Case review of 6 patients whose CHP following Kestenbaum surgery was unexpected. Results: 2 patients had a horizontal CHP shift to a vertical one and vice versa following Kestenbaum surgery. Two patients displayed an excellent surgical result, but later displayed a new CHP to the opposite side. Four of the 6 patients had further surgery for reversal of their initial horizontal Kestenbaum surgery. In attempting to reverse the prior Kestenbaum surgery, we observed that for deviations less than 20 degrees, simply recessing the two previously resected muscles was sufficient. However larger deviations require surgery on all four horizontal rectus muscles. Conclusions: This paper discusses rare and unusual responses from Kestenbaum surgery, and suggests possible ways to manage these responses.
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